Dave Solomon's State House Dome: Medicaid number in dispute

Republican leaders in the state legislature last week unveiled their long-awaited proposal to continue the expansion of Medicaid in New Hampshire, hoping to continue government-funded health insurance for the 50,000 or so Granite Staters who've come on board since eligibility was expanded as part of Obamacare.

Most of the plan has been well-known for months, but there was a lingering question as to how the state will pay for its share of the program, scheduled to rise to 10 percent of cost by 2020, or roughly $30 million, according to state Sen. Jeb Bradley, R-Wolfeboro.

The state is hoping for additional federal money and continued contributions from hospitals that benefit greatly from reductions in uncompensated care. But the linchpin of the proposal is the state's Alcohol and Drug Abuse Prevention and Treatment Fund, which currently receives 3.4 percent of profits from N.H. Liquor Commission sales.

The idea is to kick that up to 5 percent of NHLC sales, and direct the money to the state's share of expanded Medicaid. So the number of people on expanded Medicaid with substance abuse disorders is important.

A life of its own

The number 23,000 has taken on a life of its own. Bradley cited it last week, saying, "This initiative (Medicaid expansion) is the single most important way that New Hampshire can deal with the heroin and opioid crisis."

Democratic Sen. Dan Feltes of Concord, part of the bipartisan coalition in support of the bill, used the number twice in the same breath. "Over 23,000 people have accessed critical, time-sensitive drug treatment under Medicaid expansion," he said. "And that's a conservative estimate. Imagine what would have happened to them, their families and our communities if over 23,000 folks didn't get the help they need."

There's only one problem. According to the chief statistician at the Department of Health and Human Services, the number is 11,000.

Rep. John Burt, R-Goffstown, an opponent of Medicaid expansion, was suspicious about the 23,000 figure, and sought clarification from the Office of Legislative Research.

On Feb. 22, he got an email from researcher Anne Bickford quoting Andrew Chalsma, Director of Data Analytics at DHHS: "Through the first three years of the program approximately 11,000 Medicaid expansion members received some kind of substance use disorder treatment service."

When asked where the 23,000 number comes from, both Bradley and Feltes attribute it to New Futures, the advocacy organization for substance abuse recovery. Michele Merritt, president and CEO of New Futures, says the organization was quoting a June 27 letter from Gov. Chris Sununu to leaders in Congress regarding options under consideration for health care reform.

"Our Medicaid expansion has been one of the primary tools to combat our opioid crisis," the letter stated. "We know that in total more than 23,000 people have received substance use disorder services through this coverage group since it began in mid-2014."

We asked the governor's office where the 23,000 figure comes from, and did not hear back on deadline. The idea that nearly half the population on expanded Medicaid is or was in treatment for opioid addiction certainly supports the need for the program amid the opioid epidemic, and provides a rational basis for leveraging the Alcohol Fund to do so. But is it a real number?

And it's important to distinguish between treatment for opioid addiction specifically, as cited by Feltes, versus "some kind of substance use disorder treatment" cited by the DHHS statistician.

We know that treatment for alcoholism outstrips opioid addiction, especially since the courts have a system for directing alcoholics to treatment on a involuntary basis, known as the DWI arrest.

'You need accurate data'

Greg Moore, with the conservative policy group Americans for Prosperity, was the only person to testify against Medicaid expansion last week. He worked for four years at DHHS as director of public affairs and government relations under commissioner John Stephens.

"When I was at DHHS, roughly 75 percent of those receiving substance abuse treatment did so for alcohol, and the remaining 25 percent was for other drugs," he says. "Assuming that number is remotely close to the current reality, I'd speculate that the number of people receiving substance abuse treatment via Medicaid expansion for opioids is probably far closer to 3,000 than to 23,000."

Given their divergent policy objectives, Moore's estimate may be too low, the governor's too high, but lawmakers will likely want some clarity before they vote.

"If you're having a public policy debate, you need accurate data to have that discussion," says Moore.